Sunday, April 06, 2008

How should we manage acute hypertension in stroke?

Current guidelines for ischemic stroke do not recommend emergency antihypertensive therapy until the systolic BP exceeds 220 or the diastolic exceeds 120 unless TPA is administered. The guidelines for hemorrhagic stroke allow a moderately more aggressive approach to blood pressure lowering depending on the clinician’s estimate or the actual measurement of intracranial pressure.

A new study suggests a change in this management strategy. Results from a small study (reported in Medscape) presented at the American Stroke Association's (ASA's) International Stroke Conference 2008 demonstrated that immediate antihypertensive treatment targeted to a systolic blood pressure of 145 to 155 mm Hg or a drop in systolic blood pressure of 15 mm resulted in improved stroke outcomes at 3 months.

The investigators acknowledged that the results of this small study should not change clinical practice and should be considered preliminary. Moreover, the study population was a mixture of patients with hemorrhagic stroke and ischemic stroke, limiting its applicability to either subgroup.